CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation
CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation
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DOI：
10.1093/europace/eut210
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发表时间：
2014-02-01
期刊：
影响因子：
6.1
通讯作者：
Sideris, Antonios
中科院分区：
文献类型：
--
作者：
Letsas, Konstantinos P.;Efremidis, Michael;Sideris, Antonios
心房颤动（AF）患者的选择将受益最多的左心房消融仍然是不理想的。CHADS(2)评分与消融后房颤复发相关。然而，缺乏CHA(2)DS(2)-VASc评分的数据。此外，在敏感性和特异性方面，这些评分对房颤复发的准确预测价值缺乏数据。本研究旨在评估CHADS(2)和CHA(2)DS(2)-VASc评分在预测阵发性房颤单次消融后心律失常复发方面的价值。126例有症状的阵发性房颤患者（78名男性，中位年龄61岁）行左房消融。16个月（四分位数间距：10.826.0），89例患者无复发（70.6）。左房容积增大（P: 0.039）、糖尿病（P: 0.001）、血脂异常（P: 0.003）、冠状动脉疾病（P: 0.003）、III类抗心律失常药物（P: 0.017）、CHADS(2) （P: 0.006）和CHA(2)DS(2)-VASc （P: 0.016）评分与复发单因素相关。在多因素分析中，CHADS(2)（风险比为1.91,95可信区间为1.093.36,P: 0.023）和CHA(2)DS(2)-VASc（风险比为1.97,95可信区间为1.163.33,P: 0.012）与房颤复发独立相关。截断分析显示，CHADS(2)评分2（敏感性46，特异性79，受者工作特征曲线下面积，AUC 0.644）和CHA(2)DS(2)-VASc评分（敏感性57，特异性65，AUC 0.627）对房颤复发的预测价值最高。CHA(2)DS(2)-VASc评分是阵发性房颤左房消融预后的独立预测指标，其预测价值与CHADS相似(2)。然而，两者的预测精度都很一般。
The selection of patients with atrial fibrillation (AF) that will benefit most by left atrial ablation remains suboptimal. CHADS(2) score has been shown to be associated with post-ablation AF recurrences. However, data regarding the CHA(2)DS(2)-VASc score are lacking. In addition, there is paucity of data regarding the exact predictive value, in terms of sensitivity and specificity, of each of these scores as to AF recurrence. This study aimed to evaluate the merit of the CHADS(2) and CHA(2)DS(2)-VASc scores in predicting arrhythmia recurrence after a single ablation procedure for paroxysmal AF.One hundred and twenty-six patients (78 males, median age 61 years) with symptomatic paroxysmal AF underwent left atrial ablation. Over 16 months (interquartile range: 10.826.0), 89 patients were recurrence-free (70.6). Larger left atrial volume (P: 0.039), diabetes (P: 0.001), dyslipidemia (P: 0.003), coronary artery disease (P: 0.003), class III antiarrhythmic drugs (P: 0.017), CHADS(2) (P: 0.006), and CHA(2)DS(2)-VASc (P: 0.016) scores were univariately associated with recurrence. In the multivariate analysis, both CHADS(2) (hazard ratio: 1.91, 95 confidence interval 1.093.36, P: 0.023) and CHA(2)DS(2)-VASc (hazard ratio: 1.97, 95 confidence interval 1.163.33, P: 0.012) were independently associated with AF recurrence. Cut-off analysis showed that a score 2 for both the CHADS(2) (sensitivity 46 and specificity 79, area under the Receivers operating characteristic curve, AUC 0.644) and CHA(2)DS(2)-VASc score (sensitivity 57 and specificity 65, AUC 0.627) showed the highest predictive value for AF recurrence.CHA(2)DS(2)-VASc score is an independent predictor of left atrial ablation outcomes for paroxysmal AF, with a similar predictive value to CHADS(2). However, the predictive accuracy of both is mediocre.